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NPI Code Detail

MEDICARE: KERRIE CLARK COUNSELING, LLC

MEDICARE: KERRIE CLARK COUNSELING, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1982475661
Entity Type Code : Organization
Provider Name (Legal Business Name) : KERRIE CLARK COUNSELING, LLC
Provider Business Mailing Address
First Line : 5005 PLAINFIELD AVE NE STE 100
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49525-2087
Country : US
Telephone Number : 616-279-3869
Fax Number : 616-608-4657
Provider Business Practice Location Address
First Line : 5005 PLAINFIELD AVE NE STE 100
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49525-2087
Country : US
Telephone Number : 616-279-3869
Fax Number : 616-608-4657
Authorized Official
Title or Position : OWNER
Name : KERRIE CLARK
Credential : LPC
Telephone Number : 616-279-3869
Provider Enumeration Date : 01/11/2024
Last Update Date : 01/11/2024

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Directions to “KERRIE CLARK COUNSELING, LLC ” Practice Location

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